Efficacy and safety of 2-hour urokinase regime in acute pulmonary embolism: a randomized controlled trialReport as inadecuate




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Respiratory Research

, 10:128

First Online: 29 December 2009Received: 19 September 2009Accepted: 29 December 2009

Abstract

BackgroundsUrokinase UK 2 200 U-kg·h for 12 hours infusionUK-12 his an ACCP recommended regimen in treating acute pulmonary embolism PE. It is unclear whether this dose and time can be reduced further. We compared the efficacy and safety of 20, 000 U-kg for 2 hours UK-2 h with the UK-12 h regime in selected PE patients.

MethodsA randomized trial involving 129 patients was conducted. Patients with acute PE were randomly assigned to receive either UK-12 h n = 70, or UK-2 h n = 59. The efficacy was determined by the improvement of right heart dysfunction and perfusion defect at 24 h and 14 d post UK treatment. The bleeding incidence, death rate and PE recurrence were also evaluated.

ResultsSimilarly significant improvements in right heart dysfunction and lung perfusion defects were observed in both groups. Overall bleeding incidents were low in both groups. Major bleeding directly associated with UK infusion occurred in one patient in the UK-2 h group and one in the UK-12 h group. Mortality rates were low, with one reported fatal recurrent in the UK-12 h group and none in the UK-2 h group. When the rate of bleeding, death and PE recurrence were compared separately in the hemodynamic instability and the massive anatomic obstruction subgroups, no significant difference was found.

ConclusionsThe UK-2 h regimen exhibits similar efficacy and safety as the UK-12 h regimen for acute PE.

Trial RegistrationClinical trial registered with http:-clinicaltrials.gov-ct2-show-NCT00799968 Identifier: NCT 00799968

List of abbreviationsACCPAmerican College of Chest Physician

CTPAcomputed tomographic pulmonary angiography

DVTdeep vein thrombosis

ICHintracranial hemorrhage

INRinternational normalized ratio

LMWHlow molecular weight heparin

PEpulmonary embolism

RVDright ventricular dysfunction

RVED-LVEDright and left ventricular end-diastolic diameter ratio in the parasternal long-axis view

SPAPsystolic pulmonary arterial pressure

UKurokinase

V-Qventilation perfusion lung scan.

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Author: Chen Wang - Zhenguo Zhai - Yuanhua Yang - Yadong Yuan - Zhaozhong Cheng - Lirong Liang - Huaping Dai - Kewu Huang - Weixua

Source: https://link.springer.com/







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